tbuckley/cabot-search huggingface dataset:
Abstract P449: Life’s Essential 8 and Risk of Coronary Heart Disease: A Prospective Study Among Racially and Geographically Diverse Populations
Authors: Kui Deng, Deepak Gupta, Xiao-Ou Shu, Loren Lipworth, Wei Zheng, Danxia Yu
Journal: Circulation (2023)

Introduction: Life’s Essential 8 (LE8) is a new guideline proposed by American Heart Association to improve cardiovascular health, including four health behaviors (i.e., eat better, be more active, quit tobacco, get healthy sleep) and four health factors (i.e., manage weight, control cholesterol, manage blood sugar, manage blood pressure). Hypothesis: Higher adherence to LE8 is associated with reduced risk of coronary heart disease (CHD) among racially and geographically diverse populations. Methods: The current analysis was based on CHD case-control studies nested within the Southern Community Cohort Study (baseline: 2002-2009), Shanghai Women’s Health Study (1996-2000), and Shanghai Men’s Health Study (2002-2006), including 900 incident CHD cases identified through 2018 and 900 age-/sex-/race-matched controls (300 pairs of White Americans, Black Americans, and Chinese adults, respectively). Within each cohort, we constructed the LE8 score (range: 0 to 100) based on DASH diet quality, moderate/vigorous physical activity, tobacco smoking, sleep hours, body mass index, total and non-HDL cholesterol, diabetes status/blood glucose, and hypertension status/blood pressure. We used conditional logistic regression to evaluate odds ratios (ORs) between the LE8 score and incident CHD, adjusting for sociodemographic factors and family history of CHD. Results: The mean ± standard deviation (SD) of LE8 score was 48.1±13.4 among White women, 48.5±14.4 among White men, 48.1±12.3 among Black women, 50.0±13.6 among Black men, 57.2±12.2 among Chinese women, and 50.7±12.5 among Chinese men. Higher LE8 score was associated with significantly reduced risk of CHD: OR for 1-SD increase was 0.58 (95% CI: 0.51-0.65) among all participants, 0.64 (95% CI: 0.53-0.78) among White Americans, 0.57 (95% CI: 0.46-0.69) among Black Americans, 0.52 (95% CI: 0.42-0.65) among Chinese, 0.49 (95% CI: 0.41-0.60) among women, and 0.65 (95% CI: 0.56-0.75) among men; all P &lt;0.001 ( P interaction &gt;0.05 for race and P interaction =0.01 for sex). Similar patterns of beneficial associations were also found in stratified analyses by age group, education level, and history of diabetes, hypertension, or dyslipidemia, with ORs ranging from 0.46 to 0.74. Conclusions: Higher adherence to LE8 is associated with ~35-50% reduced risk of incident CHD across racially and geographically diverse populations, supporting the importance of promoting healthy lifestyles and maintaining metabolic health.
Abstract P230: Left Ventricular Structure and Function Over 25 Years of Occupational Physical Activity Exposure in Cardia
Authors: Tyler D Quinn, Abbi D Lane, Kelley P Gabriel, Barbara Sternfeld, David R Jacobs, Peter Smith, Bethany Barone Gibbs
Journal: Circulation (2023)

Introduction: Leisure-time physical activity (LTPA) is known to promote cardiovascular health, while occupational physical activity (OPA) may have paradoxically negative impacts. One proposed, though untested, explanation for the paradoxical associations may be unfavorable vascular remodeling from OPA-induced chronic cardiovascular strain. Hypothesis: High amounts of OPA over 25 years from young adulthood to midlife is associated with adverse left ventricular (LV) structure and function. Methods: Data are from 1,893 participants (48.9% female, 57.3% White, aged 30.4±3.4 years at baseline [the Year 5 exam]) from the Coronary Artery Risk Development in Young Adults (CARDIA) Study who reported working full time at baseline and two years later. LV structure and function was measured as LV mass, end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), stroke volume (SV), and e/a-wave ratio (EA) via M-mode and 2-dimensional echocardiograms at baseline and 25-years later. OPA was reported at seven exams during the study period as months/year where the participant performed “vigorous job activities such as lifting, carrying, or digging” for ≥5 hours/week. The 25-year OPA patterns were categorized into three trajectories: zero OPA (0 months/year; n=995), medium OPA (~2-3 months/year; n=526), and high OPA (~6-8 months/year; n=372). Linear regression estimated longitudinal associations between the OPA trajectories and the echocardiogram variables at final follow-up after adjusting for baseline values. Case-wise deletion was used for each model where only those with valid outcome data were included (n=623-1,475). Results: EF and EA were significantly lower in high versus zero OPA. No other statistically significant associations were observed. (Figure 1) Conclusions: In this sample, OPA’s paradoxical impact on cardiovascular health was partially supported by null or adverse associations between high OPA and LV structure and function. Confirmation is needed using more precise OPA measures.
Abstract P340: Development and Delivery of an Effective 16-week HealthEYou Program to Mitigate Metabolic Disease Risk Factors
Authors: Talya E Geller, Svetlana Nepocatych, Elizabeth Bailey
Journal: Circulation (2023)

Introduction: Metabolic syndrome (MetS) is a growing concern in the U.S and around the world. MetS is a cluster of disease risk factors including hypertension, hyperlipidemia, hyperglycemia, and obesity increasing the risk of cardiometabolic disease development. Purpose: The purpose of this study was to assess the efficacy of a 16-week nutrition and physical activity education program (HealthEYou) in mediating metabolic risk factors associated with MetS. Methods: This was a two phase study including phase 1) the use of a person-based approach and community needs assessment to develop a nutrition and physical activity education program, and 2) delivery of the 16-week workplace education program and assessment of its effectiveness. In phase 1, a survey and focus groups were used to assess the needs of the target population to develop the 16-week education program. Twenty-six participants (96% female; age: 50.1±9.2 yrs; BMI: 31.2±5.3 kg/m2) enrolled in the HealthEYou program. At baseline, 8- and 16-weeks participants completed assessments including blood pressure, body composition via Dual-energy X-ray absorptiometry (DXA) and waist circumference, 6-minute walk test, handgrip strength test, dietary intake via the Automated Self-Administered 24-hour (ASA-24) dietary assessment tool, and quality of life questionnaire. In addition, blood was drawn to assess metabolic disease risk markers (total cholesterol, glucose and hemoglobin A1c (HbA1c)). The education program consisted of 8-weeks in-person weekly interactive group (60 min) and individual goal setting (15 min) sessions and 8-weeks of weekly newsletters and two individual goal setting sessions. Results: Data was analyzed using repeated measures analysis of variance. The prevalence of MetS among the participants decreased significantly from 41.7% at baseline to 15.8% after completion of the program. There was a significant decrease from baseline compared to after 16-weeks in fat mass (36.8±10.5 kg and 34.4 ±10.47 kg, p=0.003) and HbA1c (5.36±0.40% and 5.12±0.37%, p=0.001). In addition, significant improvements in distance walked, handgrip strength, caloric intake and quality of life (p&lt;0.05) were also observed. However, no significant changes (p&gt;0.05) in total cholesterol, fasting blood glucose or systolic and diastolic blood pressure were observed at 16-weeks compared to baseline measures. Conclusion: In conclusion, the use of a person-based approach and community needs assessment was beneficial to the development of a 16-week nutrition and physical activity education program. Participants who completed the 16-week program had significant improvements in a number of metabolic risk factors. In addition, the physiological improvements corresponded with improvements in dietary intake and fitness levels, suggesting participants made positive lifestyle changes.
Abstract P665: Thoracic Aorta Calcification and Left Ventricular Structure and Function Relevant to Heart Failure: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Kelly A Watanabe, Tara Shrout Allen, Leah I Andrews, Lyndia C Brumback, Germaine G Cornelissen Guillaume, Daniel A Duprez, David R Jacobs, Michael H Criqui, Matthew A Allison
Journal: Circulation (2023)

Background: Aortic stiffness promotes left ventricular (LV) remodeling and dysfunction. Thoracic aorta calcification (TAC) contributes to aortic stiffness, but it remains unclear how TAC presence, volume, and density impact LV structure and function. We tested the hypothesis that TAC presence and higher volume is associated with increased LV mass index, decreased LV end-diastolic volume (LVEDV) index, and impaired mid-wall circumferential strain (Ecc). Methods: We evaluated 1,693 participants from the MESA who underwent chest CT and cardiac MRI from 2010 to 2012. We used linear regression models to determine cross-sectional associations between the presence, volume, and density of TAC with LV mass index, LVEDV index, and Ecc. Each pair of predictor and outcome variables underwent three model adjustments: (1) age, gender, and race/ethnicity; (2) Model 1 plus education level, height, weight, physical activity, sedentary behavior, smoking status, eGFR, SBP, DBP, anti-HTN medication use, total cholesterol/HDL ratio, statin use, and diabetes; (3) Model 2 plus coronary artery calcium (CAC) presence and volume. TAC volume and density were evaluated separately, then jointly in the same models. Results: The mean age was 69 years (SD 9) and 53% were female, while 39% were White, 26% Black, 21% Hispanic/Latino, 15% Chinese. TAC was present in 1,518 (90%) participants. TAC volume and density were highly correlated (r=0.75) with respective median 213 (25%ile, 75%ile: 36, 800) mm 3 and mean 350 (SD 110) Hounsfield Units. LV mass index, LVEDV index, and Ecc had respective means of 65 g/m 2 (SD 14), 120 mL/m 2 (SD 31), and -18.2% (SD 2.8). After full adjustment (Model 3 without density), a 10% increase in TAC volume was associated with a 1.8% multiplicative higher Ecc (i.e., less negative Ecc) (95% CI 0.2-3.4%, p=0.04) reflecting reduced LV systolic and diastolic function. Higher TAC volume was marginally associated with higher LV mass index: a 10% increase in TAC volume was associated with a 5.6% increase (-0.6-11.7%, p=0.08) in Model 2 without density, 13.9% (2.1-25.7%, p=0.03) in Model 2 with density, 3.9% (-2.5-10.4%, p=0.23) in Model 3 without density, and 11.3% (-1.0-23.7%, p=0.08) in Model 3 with density. After adjustments in Models 2 or 3, there were no other significant associations between TAC presence, volume, or density with the outcomes. Conclusions: Higher TAC volume is associated with impaired Ecc independent of CAC and marginally associated with higher LV mass index. These results suggest that the extent of TAC may influence LV remodeling and thus reduced function.
Abstract P595: Low Serum Cholesterol and Coronary Heart Disease Mortality in Veterans
Authors: Xuan-Mai T Nguyen, Yanping Li, Yuk-lam Ho, Rebecca J Song, Ariela R Orkaby, Jason L Vassy, David Gagnon, Kelly Cho, John M Gaziano, PETER WILSON
Journal: Circulation (2023)

Background: The lipid hypothesis postulates that lower blood cholesterol is associated with reduced coronary heart disease (CHD) risk, which has been challenged by recent studies that observed a U-shaped relation between cholesterol and mortality. The effect of low cholesterol and CHD risk among Veterans is unclear. Methods: This prospective cohort study included Veterans greater than 18 years of age with baseline outpatient visits from 2002 to 2007 and follow-up to December 30, 2018 in the Veterans Health Administration electronic health record system. Veterans were followed to assess CHD mortality risk in relation to outpatient blood cholesterol levels. We used Cox proportional hazard regression to estimate the hazard ratio (HR) and 95% confidence interval (CI) of CHD mortality associated with total cholesterol (TC). Results: Among 4,467,942 Veterans, 381,871 CHD deaths were recorded. We observed a V-shaped relation between TC and age-, sex, race and smoking-adjusted risk of CHD mortality. The association became U-shaped after adjustment for statin use, body mass index, hypertension, and diabetes. When further adjusted for high-density lipoprotein level, 11 baseline diseases, and applying a 2-year lag analysis, the relation to CHD mortality was J-shaped--flat for TC&lt;180 mg/dL and greater risk was present at higher cholesterol levels. Compared to Veterans with TC between 180-199 mg/dL, risk for CHD mortality (HR (95%CI)) was 1.03 (1.02-1.04), 1.07 (1.06-1.09), 1.15 (1.13-1.18), 1.25 (1.22-1.28) and 1.45 (1.42-1.49) times greater among Veterans with TC (mg/dL) of 200-219, 220-239, 140-259, 260-279 and ≥280, respectively. Transition of the TC- CHD mortality patterns were J-J-J, V-U-J and L-U-J among young, middle, and older veterans (P for interaction between TC and age group &lt; 0.001). Similar J-shaped but weaker relations were observed in statin users at baseline. Conclusions: Based on prospective data for almost 4.5 million adult Veterans, CHD mortality risk steadily increased for TC ≥200mg/dL after adjustment for a range of health conditions. Our results support the lipid hypothesis that lower blood cholesterol is associated with reduced CHD risk and lower prevalence of multimorbidity, mental health disorders, nutritional deficits, and other risk factors for CHD. Furthermore, the hypothesis remained true when TC was low due to use of statins or other lipid-lowering medication. The changes in risk for CHD mortality by TC groups observed in our study (L- to U- to J-shape) highlights the importance of fully adjusting for the presence of multimorbidity and HDL-C to avoid misleading conclusions.
Abstract P323: Three Year Changes in Adipokine Levels and Metabolic Risk Status: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ebenezer K Aryee, Sui Zhang, Bige Ozkan, Erin D Michos, Justin B Echouffo Tcheugui, Gary Gerstenblith, Roger S Blumenthal, Josef Coresh, Elizabeth Selvin, Chiadi E Ndumele
Journal: Circulation (2023)

Introduction: Adipokine levels are strongly linked to diabetes and metabolic syndrome, with higher adiponectin having protective associations and higher leptin having harmful associations. Little is known about how past changes in adipokine levels relate to current metabolic risk. Methods: Among ARIC Visit 3 (1993-1995) participants, we examined the association of past changes in adiponectin and leptin levels over the 3-year period from ARIC Visit 2 (1990-1992) to Visit 3 with prevalent diabetes and metabolic syndrome at Visit 3. Adipokines were measured using aptamer technology (correlated 0.9x with immunoassay) and analyzed categorically as &gt;50% increase, &gt;50% decrease and &lt;50% change (stable). Multivariable logistic regression was performed to assess associations with stratification by obesity (BMI ≥ 30 kg/m 2 ) status. Results: Among 9,287 Visit 3 participants, the mean age was 61 years with 56% female and 19% Black adults. Relative to stable levels, a &gt;50% increase in adiponectin over the past 3 years was associated with higher odds of prevalent diabetes (OR 1.62; 95% CI: 1.29-2.03) and metabolic syndrome (OR 1.45; 95% CI: 1.22-1.72). Past increases in leptin were associated with lower odds of diabetes (OR 0.64; 95% CI: 0.53-0.77) and metabolic syndrome (OR 0.70; 95% CI: 0.62-0.77) (Table). Compared to stable levels, &gt;50% decrease in adiponectin over time was associated with lower likelihood of diabetes and metabolic syndrome. Decreasing leptin had nonsignificant associations. Patterns were largely consistent in obesity stratified analyses, with the principal difference being that adiponectin increase was only associated with increased metabolic risk in those without obesity. Conclusion: Recent changes in adipokine levels are linked to current metabolic status. A past increase in adiponectin has direct associations, while increasing leptin has inverse associations. The underlying mechanisms and implications for metabolic risk in older age should be further studied.
Abstract P444: Estimated Power Output for a Distance Run and Maximal Oxygen Uptake in Young Adults
Authors: Gen-Min Lin, Kun-Zhe Tsai, Xuemei Sui, Carl J LAVIE
Journal: Circulation (2023)

Background: Both cardiopulmonary exercise testing (CPET) and run field test are recommended by the American Heart Association for assessing maximal oxygen uptake (VO 2 max) of youth. Power output was highly correlated with VO 2 max in a CPET. However, it is unclear the correlations of time and estimated power output (EPO) for a run field test with VO 2 max obtained from a CPET in young adults. Methods: This study included 45 participants, aged 20-40 years, from a sample of 1,120 military personnel who completed a 3000-m run field test in Taiwan in 2020. The participants subsequently received a CPET with the Bruce protocol to assess VO 2 max in the same year. According to the physics rule, EPO (watts) for the run field test was defined as a product of half body mass (kg) and [distance (3000-m)/time (s) for a run field test] 2 . Pearson product-moment correlation analyses were performed. Results: The Pearson correlation coefficient (r) of time against EPO for the run field test was estimated 0.708 (p &lt;0.001). The correlation coefficient between time for the run field test and VO 2 max (L/min) in a CPET was estimated 0.462 (p =0.001). By contrast, the correlation coefficient between time for the run field test and VO 2 max scaled to body mass in a CPET was estimated 0.729 (p &lt;0.001). The correlation coefficient of EPO for the run field test against VO 2 max in a CPET was estimated 0.813 (p &lt;0.001). Conclusion: In young adults, although time for a run field test was a reliable estimate of VO 2 max scaled to body mass, EPO proportionally to the mean velocity squared was found as a superior estimate of VO 2 max.
Abstract P220: Dietary Patterns and Lower Risk of Early Stage of Renal Dysfunction in 9-Year Follow-Up in a Japanese General Population: Tanushimaru Cohort Study
Authors: Nagisa Morikawa, Mika Enomoto, Ako Fukami, Hiromi Sato, Hisashi Adachi, Yoshihiro Fukumoto
Journal: Circulation (2023)

Introduction: Chronic kidney disease (CKD) is a growing public health problem with aging society and a progression to end-stage renal disease is associated with a higher risk of death. Previous studies have suggested that healthy dietary patterns like vegetable-based diet may reduce risk of incident CKD in general populations. However, there is less evidence on whether dietary patterns have impact on early stage of renal dysfunction (RD). Therefore, we investigated the longitudinal association between dietary patterns and early stage of RD in a general population. Methods: We recruited 1943 men and women aged 40 to 95 years in the prospective Tanushimaru cohort study in Japan in 2009. Their dietary intake was assessed using a brief self-administered diet history questionnaire (BDHQ). Principal component analysis (PCA) identified the main dietary patterns. In 984 participants re-examined in 2018, estimated glomerular filtration rate (eGFR) was calculated by CKD-EPI method in 2009 and 2018. RD and early RD were defined as eGFR &lt; 60 and &lt; 90 mL/min/1.73m 2 , respectively . Multivariable linear and logistic regression analyses were performed to examine the association of the main dietary patterns in 2009 with RD and early RD in 2018. Covariates included cardiovascular risk factors and eGFR at baseline. Results: Mean levels of eGFR in 2009 and 2018 were 94.0 and 84.3 mL/min/1.73m 2 . The prevalence of RD and early RD in 2018 were 8.8% (n=87) and 58.5% (n=576), respectively. The PCA revealed three major dietary patterns: vegetable pattern (vegetables, mushrooms and seaweeds); rice pattern (rice, bread and miso soup); and alcohol pattern (alcoholic beverages, cakes and snacks). The higher vegetable pattern score was significantly associated with higher eGFR in 2018 (p=0.006) and modestly associated with lower risk of early RD (p=0.06), but not RD (p=0.1) in the fully-adjusted models. Conclusions: The vegetable pattern was significantly associated with higher eGFR and may prevent an early stage of RD in a 9-year follow-up.
Abstract P557: A Landscape Analysis of Team-Based Care for Hypertension Control in Low-and Middle-Income Countries
Authors: Oluwabunmi V Ogungbe, Danielle Cazabon, Andrew E Moran, Dinesh Neupane, Cheryl R Dennison Himmelfarb, Anbrasi Edward, George Pariyo, Lawrence J Appel, Kunihiro Matsushita, Hongwei ZHANG, LIU Tong, Dessie Girma, Addisu Worku, Sohel Reza Choudhury, Shamim Jubayer, Mahfuzur Rahman Bhuiyan, Shahinul Islam, Kufor Osi, Joseph Odu, Obagha Chijioke Emmanuel, Ojji Dike, Mark D Huffman, Yvonne Commodore-Mensah
Journal: Circulation (2023)

Introduction: A team-based care approach to hypertension care in low-resource settings is an effective strategy for improving hypertension control. Objective: In this multi-country survey, we assessed the extent to which team-based care is operationalized for hypertension care in low- and middle-income countries (LMICs), and the perception of hypertension program experts and health care workers (HCWs). Methods: Two surveys were administered; the first survey (Country Profile Survey), administered in 25 countries, sought to identify the current tasks of HCWs from perspectives of national representatives involved in public health programming. The second survey (HCW Survey), administered among HCWs in four LMICs; Bangladesh, China, Ethiopia, and Nigeria, aimed to understand current practices of HCWs, perspectives on team-based management of hypertension, and barriers and facilitators. Results: In the Country Profile Survey, all countries surveyed allowed team-based care for basic clinical hypertension management tasks, but less for advanced tasks (9/25, 36%). In the HCW survey, 854 HCWs from four countries participated: 47% (401/854) work in rural settings. Although there were slight variations by country, overall, barriers to team-based hypertension care were similar, including: inadequate training of HCWs (83%), regulatory issues (76%), resistance by patients (56%), and opposition by physicians (42%) and nurses (40%). Perceived facilitators of team-based hypertension care were use of treatment algorithms (94%), telehealth/m-health technology (92%), and adequate compensation for HCWs (80%) ( Figure A-B ). Conclusions: These surveys revealed key targets for health systems and governments to facilitate team-based care implementation. Specifically, policies to provide additional training, optimize HCWs roles within the care team, and establish hypertension treatment protocols and telehealth/m-health are essential.